Heartburn sufferers to be screened by NHS to check it's not oesophageal cancer

Landmark NHS trial launched by Cambridge University scientists to check people's heartburn hasn't developed into oesophageal cancer - and how you can get checked

A landmark trial has been launched to see if everyone in Britain with persistent heartburn should be screened for oesophageal cancer.

A “pill on a string” technology detects abnormalities from a condition known as Barrett's oesophagus, which makes a person more likely to develop oesophageal cancer. Cambridge University researchers will recruit 120,000 participants over the next three years who will swallow a dissolvable pill on a string. This will release a sponge the size of a 50p coin to collect cells from the oesophagus before it is retrieved for analysis. People who regularly take medication for heartburn will be invited to join with a text message from the NHS.

Professor Rebecca Fitzgerald, director of the Early Cancer Institute at Cambridge, and inventor of the test, said: "The capsule sponge is changing how we detect Barrett's oesophagus and oesophageal cancer. Catching it earlier can save lives by reducing the need for chemotherapy and surgery to remove the oesophagus."

People with frequent heartburn and gastroesophageal reflux disease (GERD) see stomach acid flow back into the esophagus, which can irritate the lining and lead to inflammation. This inflammation can eventually transform the cells of the esophagus lining, which can lead to Barrett's oesophagus and in a small percentage of cases progress to cancer.

As part of the trial, patients will visit mobile vans for the 10-minute test, where they will be given a small, coated pill attached to a thread. When a patient swallows the pill and it reaches the stomach, the coating dissolves and the sponge inside it expands to the size of a 50p coin. The sponge collects cells from the oesophagus as it is gently pulled out from the stomach by a nurse or GP. The cells are sent for testing for two proteins called Trefoil Factor 3 (TFF3), which is only found in Barrett’s oesophagus, and altered p53 protein, which identifies cells which are starting to grow out of control and become oesophageal cancer.

The Best4 Screening trial has been hailed as the "pinnacle of many years of painstaking research" by experts. It could save lives and reduce the need for "labour-intensive" endoscopy - a camera down the throat - which is currently the "gold standard" to diagnose and treat this type of cancer.

Co-principal investigator Professor Peter Sasieni, of Queen Mary University of London, said: “Most people with Barrett’s oesophagus have heartburn, but most people with heartburn don’t have Barrett’s oesophagus. We have already shown that the capsule sponge can reliably identify people with Barrett’s oesophagus. Now we need to show that using it in a targeted screening programme can help prevent oesophageal cancer and reduce deaths from this disease. The BEST4 Screening trial will involve over a hundred thousand people joining across the UK. It is a huge undertaking which will take many years, but it is important that we find out whether a new routine screening programme really will prevent cancers and save lives.”

Over 9,000 Brits are diagnosed with oesophageal cancer every year and it claims 22 lives every day. The most common symptom of esophageal cancer is difficulty swallowing, which can feel like pain or burning, or like food getting stuck in the throat. Other symptoms include unexplained weight loss, Increased acid reflux, pain in the throat or behind the breastbone, feeling tired and generally unwell.

Michelle Mitchell, chief executive of Cancer Research UK, which is funding the trial, said: "Around 59% of all oesophageal cancer cases are preventable. Yet endoscopy, the gold standard for diagnosing and treating this cancer, is labour-intensive and not practical for a population screening programme. This device is a remarkable invention by Professor Fitzgerald and her team, and previous trials have shown how powerful it can be in identifying cancer earlier. Cancer Research UK is proud to be supporting this landmark clinical trial, bringing the capsule sponge test into the community and offering it to a much wider group of patients. After many decades of research, we're on the cusp of transforming oesophageal cancer diagnosis forever."

Case Study

Paul Anderson, 59, started getting acid reflux a decade ago and is one of the first participants to join the trial. The stock controller from St Neots, who takes pills to manage the condition, said: "I'd never been on a clinical trial before, but when the invitation came for this one, I felt I had to sign up as the acid reflux had flared back up again. I'm hoping that it may give me some more insight into my chronic heartburn, as well as helping people who may have similar concerns about their health."

Click HERE for more information on how to join the trial or email cuh.best4.trial@nhs.net